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Clinical Problem Solving: Radiology
March 2009

Radiology Quiz Case 1

Author Affiliations

Copyright 2009 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2009

Arch Otolaryngol Head Neck Surg. 2009;135(3):316-319. doi:10.1001/archoto.2008.551-a

A 56-year-old Woman presented to her general practitioner with a 2-day history of general malaise, sore throat, and a feeling of a lump in the throat. Her physician did not detect anything abnormal on physical examination and diagnosed an upper respiratory tract infection. Cephalexin therapy was initiated, with slight improvement. The next day, the patient swam in the sea and immediately afterward noticed marked and rapid neck swelling, which was demarcated by the neckline of her swimsuit (Figure 1). She immediately presented to her otolaryngologist describing further symptoms of dysphagia, odynophagia, and dysphonia without stridor. She was a nonsmoker and did not drink alcohol. Her first cousin had “hereditary clotting problems,” the nature of which was unclear. She had previously undergone several operations, including hernia repair and dental extractions, with no excess bleeding noted. She was nulliparous.